Reflux of acid can lead to a sore throat and can lead to coughing. The usual treatment is to see an ENT surgeon to make sure there is nothing amiss. If nothing can be found, then a gastroenterologist could do treatment for acid reflux.

The symptoms of H. pylori infection are difficult to define. Practically any type of symptom between the nipples and the bellybutton could be coming from the stomach and could be caused by H. pylori. For many years doctors recognised that it was not possible to detect which patients had ulcers, that is why diagnosis always requires an endoscopy.

H. pylori is always associated with gastritis, an inflammation of the stomach in which white cells infiltrate into the stomach lining. It is believed that these white cells can in themselves cause damage and ultimately lead to weakness in the stomach lining, which is the cause of the ulcer. This process is explained elsewhere on the Helicobacter Foundation web pages.

Because of the above, any stomach symptom could possibly be caused by H. pylori. Heartburn is related to a leaky valve at the lower oesophagus and the arrival of acid from the stomach into the oesophagus. Thus, heartburn could be related to H. pylori if some H. pylori patients produce excessive acid (this is known to occur) or if H. pylori leads to some slowing of emptying of the stomach acid (this sometimes occurs when the pylorus valve at the bottom of the stomach is narrowed). Burping symptoms are usually related to some problem at the lower oesophageal sphincter, allied to heartburn, reflux and hiatus hernia. Since I believe patients with H. pylori are more likely to vomit, I also think they are more likely to damage their lower oesophageal sphincter over the years and be more susceptible to symptoms such as burping. The production of gas in the stomach comes from carbon dioxide seeping through the stomach wall, and it is possible that H. pylori can increase the amount of carbon dioxide present in the stomach ie. causing burping. Patients who burp excessively however, are often actually swallowing small amounts of air and burping it back up to relieve a discomfort they have related to an oesophageal sphincter problem, as discussed above. Burping can sometimes also occur when the stomach is slow to empty and food in the stomach ferments, releasing gas.

Symptoms of nausea associated with vomiting are quite likely to be caused directly by a stomach condition and can be symptoms of H. pylori infection. If the vomit is initially clear and subsequently contains blood, it is likely to be caused by a tear in the lower part of the oesophagus caused by the initial vomiting. If blood is present in the vomiting, it can also be caused by a bleeding ulcer in the stomach. The appearance of blood in vomit is either red (a recent or large bleed) or dark brown (bleeding in the last hour or so with changed blood affected by stomach acid). Blood in the stomach can also appear black if it has been resting in the stomach for a few hours. When bleeding occurs in the stomach and blood comes in contact with stomach acid it is then changed to a black colour, so that the patient with significant stomach bleeding (more than 200 mls) is likely to have black stools, which is called melena.

When H. pylori and gastritis cause delay in gastric emptying patients may feel bloated or full after a normal sized meal ("early satiety").

The opposite can also occur in a few patients. For example, a patient may state that after eating nutritious and tasty food they still feel hungry ("as if the food has not done me any good"). I believe this symptom is associated with low acid secretion and is also sometimes described by patients on acid lowering drugs.

Early satiety (fullness) can possibly also be caused just by the inflammation of the lining of the stomach, since the stomach does not easily expand as well as a healthy stomach, and the stomach lining is rather sensitive to stretching.

Pain in the stomach and duodenum is often described as "gnawing", which is somewhat hard to describe, but typically is a symptom of severe hunger and nausea combined so that the patient with gnawing is not sure whether he should vomit or eat! This symptom is typical of duodenal ulcer patients who have gnawing when the stomach is empty. The best cure is a very small, light snack or taking acid lowering drugs.

Symptoms of gas and flatulence below the stomach are often hard to cure. The causes of gas in the intestine are fermenting sugars, and this can result from any kind of maldigestion of sugar, including maldigestion of sugars that are not digestible ie. beans! Maldigestion of milk sugar is called lactose intolerance. In patients with lactose intolerance colicky pain, gassy symptoms and diarrhoea can sometimes result after drinking milk. Patients who have a high fibre diet may not tolerate it particularly well and sometimes complain of distension and gas. In rare cases, bacterial colonisation of the intestine can result in fermenting of sugars in food before the food is absorbed. This also leads to gas symptoms.

Patients with H. pylori complain of many weird symptoms, including abdominal swelling. There is no guarantee that these symptoms are caused by H. pylori or will improve after treatment. However, patients with undiagnosed symptoms and H. pylori infection may choose to try a course of H. pylori eradication therapy.

No. There is some data to show that H. pylori patients have low iron levels perhaps due to low grade bleeding from their stomach during their lifetime.

Some people feel tired, run down and depressed when they have H. pylori. In a double-blind study of ulcer patients, we found that eliminating H. pylori caused increased wellbeing and a more positive attitude in the patients even though they did not know whether or not they had the H. pylori eradicated (it was a placebo controlled study). Since quite severe inflammation can be present in the stomachs of patients with H. pylori infection, it is not unreasonable to see that they would feel unwell. Some of these feelings may be subtle and could easily be a part of a depression syndrome. If a patient with depression is found to have H. pylori infection, I would probably treat the H. pylori as well as managing the depression. Patients who have spent time in institutions during their life are quite likely to be affected with H. pylori infection.

The on-line list of medical journals may provide you with further information about the link between H. pylori and cardio-vascular disease. At present this link is in dispute. There have been articles in the Lancet and the British Medical Journal.

If you have not had a breath test after treatment then we are not sure if you still have H. pylori. There is no reason why you should have gas after drinking water. Any stretching of the stomach is likely to release gastrin, which causes the colon to contract, so may result in a bowel action or passing gas (ie. as might occur after a normal meal). Alternatively, you have the "early satiety" syndrome.

When H. pylori and gastritis cause delay in gastric emptying patients may feel bloated or full after a normal sized meal ("early satiety").

Early satiety (fullness) can possibly also be caused just by the inflammation of the lining of the stomach, since the stomach does not easily expand as well as a healthy stomach, and the stomach lining is rather sensitive to stretching.